BackTable / Urology / Podcast / Episode #51

Management of Post-Prostatectomy Erectile Dysfunction

with Dr. Darshan Patel and Dr. Mike Hsieh

In this episode of BackTable Urology, Dr. Bagrodia discusses erectile dysfunction (ED) in the setting of post-prostate cancer treatment with Dr. Mike Hsieh and Dr. Darshan Patel, two urologists from the comprehensive men’s health clinic at UC San Diego Health.

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Management of Post-Prostatectomy Erectile Dysfunction with Dr. Darshan Patel and Dr. Mike Hsieh on the BackTable Urology Podcast)
Ep 51 Management of Post-Prostatectomy Erectile Dysfunction with Dr. Darshan Patel and Dr. Mike Hsieh
00:00 / 01:04

BackTable, LLC (Producer). (2022, August 24). Ep. 51 – Management of Post-Prostatectomy Erectile Dysfunction [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Darshan Patel discusses Management of Post-Prostatectomy Erectile Dysfunction on the BackTable 51 Podcast

Dr. Darshan Patel

Dr. Darshan Patel is a urologist from the comprehensive men’s health clinic at UC San Diego Health in California.

Dr. Mike Hsieh discusses Management of Post-Prostatectomy Erectile Dysfunction on the BackTable 51 Podcast

Dr. Mike Hsieh

Dr. Darshan Patel is a urologist from the comprehensive men’s health clinic at UC San Diego Health in California.

Dr. Aditya Bagrodia discusses Management of Post-Prostatectomy Erectile Dysfunction on the BackTable 51 Podcast

Dr. Aditya Bagrodia

Dr. Aditya Bagrodia is an associate professor of urology and genitourinary oncology team leader at UC San Diego Health in California and adjunct professor of urology at UT Southwestern.

Show Notes

First, the doctors explain their typical workup of post-prostatectomy patients. They widely use questionnaires, especially the Sexual Health Inventory for Men Score (SHIM Score) to coordinate with oncology colleagues and keep their ED assessments standardized. Because ED treatment should be tailored to the goals and expectations of each patient, taking a thorough social history is also important. Both doctors concede that robotic surgery has improved post-procedure urinary symptoms but emphasize that not many therapies are able to lower the rate of ED as a post-operative complication. Additionally, a combination of radiation and androgen-deprivation therapy can lower libido. For this reason, an early sexual function rehabilitation approach is important. Dr. Hsieh equally prioritizes both goals of resolving a patient’s prostate cancer and preventing postoperative incontinence and sexual dysfunction.

There are many ED therapies available for prostate cancer survivors. Patients can be started on a vacuum erection device and low dose of PDE5 inhibitor (Cialis, Tadalafil) even before their prostatectomy procedures. Dr. Patel notes that timing of the PDE5 inhibitor is one of the most important factors to consider in penile rehabilitation. Vacuum erection devices are viable options to preserve penile size for single patients or patients who are not having sex. Next, the doctors discuss injection therapy. Dr. Hsieh and Dr. Patel usually show patients how to inject the first dose of Trimex in the office and advise patients against making big dosage jumps to prevent the development of priapism. Dr. Bagrodia mentions that pelvic floor physical therapy and sex counseling as good non-invasive and non-pharmacological options as well. Finally, the doctors discuss less common penile rehabilitation therapies, such as hyperbaric oxygen and shockwave therapy.

Lastly, they discuss how to manage patient expectations. Although early spontaneous erection and fullness is a good sign of recovery, the urologist should set three-, six-, and nine-month milestones for their patients. Usually, 80% to 90% of patients usually graduate from therapy within a year of their prostatectomy, and it is beneficial to use as many non-surgical options as possible to regain erectile function at first.

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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